POS0055 BEYOND THE WINDOW: EFFECTS OF LONG-TERM TIGHT CONTROL IN EARLY-TREATED RHEUMATOID ARTHRITIS UNDER REAL-LIFE CONDITIONS
Authors: L. Rebouças, A. De Afonseca Dias e Silva, C. Albuquerque, A. P. Gomides, N. De Carvalho Sacilotto, R. Giorgi, A. B. Vargas-Santos, S. Radominski, I. Pereira, M. F. Guimarães, M. Bertolo, P. Louzada, M. D. F. Sauma, K. Bonfiglioli, C. Brenol, F. Borghi, L. Mota, G. Da Rocha Castelar Pinheiro
Journal: Annals of the Rheumatic Diseases (2023)

<h3>Background</h3> Early treatment, within the window of opportunity, treat-to-target-(T2T) and tight control (TC) are fundamental principles of management in rheumatoid arthritis (RA). The Brasília Cohort of Early Rheumatoid Arthritis (BSB Cohort) is a real-life cohort designed and conducted under these principles.[1] The REAL study (Rheumatoid Arthritis in Real Life in Brazil) is a prospective multicentric cohort of patients with RA encompassing 11 public healthcare centers in Brazil, designed to reflect real-life, conventional managements conditions.[2] <h3>Objectives</h3> To compare early-treated patients with RA managed under the principles of T2T and TC vs. those exposed to conventional management in the long term, as for relevant clinical and radiographic outcomes, in real-life settings. <h3>Methods</h3> Participants from the BSB Cohort (under T2T and TC management) were compared to three randomly selected subsamples from the REAL study (REAL1, REAL2 and REAL3, exposed to conventional management). All patients initiated treatment with disease-modifying drugs (DMARD) within one year of symptom onset. The groups were compared regarding the occurrence of erosive disease, use of corticosteroids (CE) and immunobiologicals (bDMARD), remission rates according to DAS 28-ESR and physical function (Health Assessment Questionnaire - HAQ). <h3>Results</h3> A total of 256 patients were included (64 from the BSB Cohort and 64 patients from each of the REAL1, 2 and 3 subsamples), predominantly female (88.3%), white (52%), with a mean age of 53.7 years, positive rheumatoid factor (73.4%), mean total disease duration of 94.1 months and delay time between first symptoms and use of first DMARD of 6.94 months. The groups compared did not differ significantly in terms of gender (χ<sup>2</sup> =6.19, p=0.103), race (χ<sup>2</sup> =7.68, p=0.053), age (F=1.28, p=0.279), presence of positive rheumatoid factor (χ<sup>2</sup> =1.89, p=0.594), mean disease duration (F=1.96, p=0.120) and time delay of symptoms until use of the first DMARD (F=0.34, p =0.793). The BSB Cohort showed significantly less frequency of erosive disease, use of CE and bDMARD, and higher DAS 28-ESR remission rate (Figure 1). Mean HAQ score was lower in the BSB Cohort (0.546) than in the REAL1 (1.033), REAL2 (0.821) and REAL3 (0.748), F=5,23, p=0,02. Mean DAS 28-ESR was lower in the BSB Cohort (2,90) than in the REAL1 (3,68), REAL2 (3,44) and REAL3 (3,21), F=3,43, p=0,018. <h3>Conclusion</h3> Under real-life conditions, in the long-term, adherence to T2T and TC principles was found essential to preserve the expected benefits of the early RA treatment within the window of opportunity, in terms of less occurrence of erosive disease, less use of CE and bDMARD, higher DAS 28-ESR remission rate and better physical function (lower HAQ score). <h3>References</h3> [1]da Mota LM, Laurindo IM, dos Santos Neto LL. Demographic and clinical characteristics of a cohort of patients with early rheumatoid arthritis. <i>Rev Bras Reumatol</i>. 2010;50(3):235-248. [2]da Rocha Castelar-Pinheiro <i>et al.</i> The REAL study: a nationwide prospective study of rheumatoid arthritis in Brazil. Advances in Rheumatology (2018) 58:9. <h3>Acknowledgements:</h3> NIL. <h3>Disclosure of Interests</h3> None Declared.